Pathological examination of the placenta in small for gestational age (SGA) children with or without postnatal catch-up growth

Background/objective: Approximately 10% of small for gestational age (SGA) infants fail to catch up. The relationship between postnatal growth and placental pathology in SGA infants remains unclear. Our aim was to assess the involvement of placental pathology in postnatal growth of SGA infants.

Methods: We retrospectively evaluated placental pathology and postnatal growth in single-pregnancy infants born after 37 gestational weeks in our institution, with both birth weight and length below ?2 standard deviation scores (SDS) of the normal weight and length. “Catch-up” was defined as height reaching ?2 SDS before the second birthday. Pathology of the placenta was classified into: abnormality due to maternal factors or fatal factors, villitis of unknown etiology (VUE), other abnormalities and no abnormality.

Results: Of the 33?084 infants, 142 met our criteria and 49 of them had analyzable data. The overall catch-up rate was 84%. Catch-up growth took place in all infants with no placental abnormality and only 57% of infants with abnormality due to fatal factors. There was no significant relationship between catch-up rate and other factors.

Conclusion: Placental pathology is associated with postnatal growth in SGA children born at term. Placental abnormality due to fetal factors is related to poor catch-up rate.     

Auxological and metabolic study in small for gestational age children during 2 years follow-up

Objective.?To compare auxological and metabolic status of preterm (PT) and fullterm (FT) small for gestational age (SGA) babies from birth until age 2 years and to study the role of intrauterine growth retardation (IUGR) in auxological and metabolic outcome in SGA babies.

Methods.?We enrolled 44 SGA babies (22 FTs, 22 PTs) followed up six monthly. Anthropometric and metabolic measurements (fasting glucose, basal insulin level, total-cholesterol, triglycerides) were performed. HOMA-IR was selected to assess insulin sensitivity.

Results.?Both FTs and PTs from birth to age 6 months showed a significant increase in weight and length; the weight gain decreased from 6 to 12 months only in PTs. At 24 months, we observed catch-up growth in 90% of FTs and 87% of PTs. Insulinemia and HOMA-IR decreased from birth to 24 months, in particular between 6 and 12 months. PTs SGA with IUGR were significantly smaller than FTs SGA without IUGR (p?=?0.01) and showed a lower length growth velocity. Moreover they showed also higher insulin levels and HOMA-IR at birth; these values decreased at 12 and 24 months.

Conclusions.?Our study showed no significant difference between PTs and FTs SGA in auxological and metabolic parameters. However, prematurity with IUGR proved to be a significant factor that should be considered in the timing of auxological follow-up of SGA subjects.     

Severity of Hypertension in Pregnancy and Morbidity in the Newborn

A prospective study on the effect of severity of hypertension in pregnancy on peri- and neonatal morbidity was conducted over a 22 month period in 1984 - 1986 at Kuoplo University Central Hospital. Five hundred and fifty-four babies without major anomalies were born alive to hypertensive and 3212 to normotenslve mothers. The Incidence of prematurity was highest (22%) among babies with maternal pre-eclampsia, Intrauterine growth retardation (IUGR) being the most frequent (42%) among preterms from this group.

All preterm babies born at 28 - 36 gestational weeks were included for analysis of peri- and neonatal morbidity, 36 “in the pre-eclampsia group, 17 in the pregnancy-induced hypertension group, 11 in the chronic hypertension group and 162” in the normotenslve control group. The respective numbers of babies “in the full-term sample were 49, 74 and 51″ in the hypertension subgroups and 220” in the normotenslve control group.

Among preterm babies maternal pre-eclampsia was associated with the highest neonatal morbidity and birth asphyxia, expressed as reduced optimality scores, and with the lowest birth weight and length. Among full-term babies those with chronic maternal hypertension had the highest neonatal morbidity and birth asphyxia even though babies with maternal pre-eclampsia had the lowest birth weight. When appropriate for gestational age (AGA) and small for gestational age (SGA) children were examined separately, the differences described between the hypertension subgroups and their controls were found mostly between AGA children. Maternal hypertension explained 22% of the between-group differences” in preterm children, mostly via Increased IUGR, and 12%” in full-term children, mostly via increased neonatal morbidity.     

Evaluation of symphysis-fundus measurements and weighing during pregnancy.

To evaluate the value of using symphysis-fundus (SF) distance and maternal weight gain measurements in predicting an infant's birth weight, these measurements were analysed in 831 single-birth deliveries at Aker University Hospital during a period of 3 months. Of the 96 babies with a birth weight below the 10th percentile for gestational age, 39 (41%) could be detected by a series of SF-measurements. For every third correctly identified SGA (small for gestational age) baby, there were 7 false positive predictions. Only 13 (14%) of the mothers who gave birth to SGA babies demonstrated a weight gain at each medical check-up during pregnancy, whereas 197 (30%) of the women giving birth to normal-weight babies showed a weight gain each time (p = 0.02). However, for maternal weight gain, both predictive value (14%) and specificity (29%) were low. Hence, these two screening methods for the detection of SGA babies remain imprecise in practice. Test procedures should be improved, and factors influencing fetal growth should be emphasized to detect fetuses at risk.     

Body mass index change between pregnancies and small for gestational age births

OBJECTIVE: To estimate whether maternal weight changes between pregnancies influence the risk for small for gestational age (SGA) births. METHODS: SGA cases (n = 8,062) below the tenth percentile birth weight for gestational age were selected from liveborn singletons born of Missouri residents during 1989-1997. Normal weight controls (n = 8,062) were selected according to birth year. The risk of SGA from interpregnancy body mass index (BMI) change and other maternal factors was estimated using logistic regression analysis. RESULTS: An increase in BMI between pregnancies decreased SGA risk (adjusted odds ratio = 0.8; 95% confidence interval 0.7, 1.0). Other risk factors were prior SGA (4.4; 4.0, 4.8), preeclampsia/eclampsia (2.6; 2.1, 3.2), maternal cardiac disease (1.8; 1.1, 2.9), inadequate weight gain (1.9; 1.8, 2.2), and cigarette smoking (1.9; 1.7, 2.3 for 1-9 cigarettes per day; 2.5; 2.2, 2.8 for 10-19/d; and 2.8; 2.5, 3.3 for 20/d or more). CONCLUSION: Increase in interpregnancy BMI lowers SGA risk, but adequate weight gain during pregnancy is more effective.     

Does the antenatal detection of small-for-gestational-age babies influence their two-year outcomes?

The aim of this paper is to determine whether antenatal detection of small-for-gestational-age (SGA) babies influences 2-year outcomes. All low-birth-weight (<2,500g) infants born in South-EastThames region, England from September 1, 1992 to August 31, 1993 were identified at birth. Antenatal "suspicion" and ultrasound assessment confirming growth restriction was categorized as "detection" of SGA. Postnatally, infants were classified as SGA if they had a birth weight for given gestation below the 10th centile. At 2 years, those below 32 weeks' gestation and a random 25% sample of infants of 32 weeks' gestation or more underwent pediatric assessments. Of 49,787 births, 3,456 (6.9%) were of low birth weight. One thousand four hundred and fifty one (42.5%) were SGA, of whom 611 (42%) were detected antenatally by ultrasound scan. At 2 years, 1,008 (75.8%) of 1,358 expected infants were assessed, 379 (37.6%) were SGA at birth, and 188 (49.6%) were confirmed antenatally. Although undetected infants had higher mean birth weights and gestational ages, they had a higher proportion of perinatal deaths (12.6 vs. 6.4%, RR 1.96: CI 1.32-2.86) than detected infants. At 2 years, detected SGA infants had smaller head circumferences (p = 0.026), a higher prevalence of febrile convulsions (8.0 vs. 3.1 %: p = 0.040) and lower scores on the locomotor (DQA) scale of Griffith's developmental test (p = 0.021) compared with undetected SGA infants. Despite detected SGA fetuses having lower weights and gestation at birth than undetected fetuses, they had significantly lower mortality without a parallel increase in severe 2-year neuro-developmental, clinical, or growth morbidity.     

Modifiable risk factors for growth restriction in twin pregnancies

OBJECTIVE: This study was undertaken to evaluate modifiable risk factors for adverse fetal growth in twin pregnancies. STUDY DESIGN: A large cohort study from a database of women with twin gestations identified at risk for preterm labor was performed. Examining each infant's birth weight and gestational age at delivery, infants were classified as being average (AGA), large (LGA), or small (SGA) for gestational age, using the Alexander reference curve. Clinical and demographic factors were compared between patients delivering at least 1 SGA infant and AGA pairs using Pearson's chi2 Student t test statistics and logistic regression. RESULTS: There were 11,827 twin pregnancies evaluated. Risk factors associated with SGA deliveries included tobacco abuse, poor weight gain, lean prepregnancy body mass index, African American race, and nonmarried. The logistic regression identified tobacco abuse as the single greatest risk for poor fetal growth, (odds ratio [OR] 1.95; 95% CI [1.68, 2.27]). Weight gain of less than one-half lb/wk also increased SGA risk (OR 1.35; 95% CI [1.16, 1.68]), whereas weight gain greater than 1 lb/wk decreased SGA risk (OR 0.77; 95% CI [0.68, 0.86]). CONCLUSION: Tobacco abuse and weight gain are the modifiable risk factors, which require intervention during a twin pregnancy. Patients should be encouraged to stop tobacco abuse and gain a minimum of one-half lb/wk in the later half of pregnancy to minimize the risk for growth restriction.     

Early postnatal growth in preterm infants and cord blood leptin.

Although circulating leptin and insulin concentration is linked to intrauterine growth, fetal development and birth weight in full-term infants, there has been no enquiry into the influence of cord blood insulin and leptin for catch-up growth in preterm infants. The study evaluated the association of cord blood leptin with growth and weight gain of 96 premature babies during 6 months (corrected age). The temporal changes of anthropometric indexes over this period were calculated by repeated random regression (PROC MIXED) using SAS. Cord blood leptin was negatively associated with the rate of change in BMI (p=0.01) and length (p<0.001), from birth until 64 postnatal weeks. Insulin was positively associated with the change rate in BMI (p=0.03); however, this disappeared when adjusted for birth weight. For the first time, the association between lower leptin levels with greater catch up growth is shown for both BMI and length among preterm children. In conclusion, leptin levels at birth, but not insulin levels, predict growth rates.     

Severe life events and impaired fetal growth: a nation-wide study with complete follow-up

BACKGROUND: To estimate the association between severe maternal life events and infants small for gestational age at different gestational ages at birth. METHODS: From 1980 to 1992 all women exposed to severe life events such as death or first hospitalization for cancer or acute myocardial infarction in partners or children during pregnancy or up to 485 days before were identified through national registers. We included all 3,402 exposed pregnancies and 19,551 unexposed pregnancies randomly selected to the control cohort and performed adjusted stratified Cox proportional hazards regression analyses with time-dependent covariates. RESULTS: These life events were not associated with SGA in general, but exposed infants born before 32 weeks of gestation had twice the risk for being born with a birth weight相似文献   

Impact of hypertensive disorders of pregnancy at term on infant birth weight

This study was performed to investigate the impact of hypertensive disorders of pregnancy at term on neonatal birth weight. All singleton live births delivered between 37 and 42 weeks of gestation complicated by hypertensive disorders over a 7-year period (n = 362) was compared to 34 783 uncomplicated singleton deliveries in the same period. The individualized gestation-related optimal weight (GROW) was calculated for each individual case adjusted for the effects of maternal booking weight, height, parity, gestation at delivery, and fetal sex. Small-for-gestational-age (SGA) was defined as a birth weight less than the 10th percentile of the GROW. The incidence of SGA babies was significantly higher in subjects with preeclampsia and eclampsia than in control subjects (24.6 versus 11.3%; odds ratio = 2.55; 95% CI: 1.84, 3.55). Preeclampsia significantly reduced fetal birth weight by 130 g or 4.3%. Those with eclampsia on average had a neonatal birth weight 349 g or 11.0% below that of the GROW. In contrast, there was no significant difference in the incidence of SGA babies or degree of deviation from GROW between those with or without gestational hypertension.     

Comparison of umbilical blood gas and acid-base status of small-for-date and normal Chinese newborns.

A prospective study of umbilical arterial blood gas in appropriate-for-gestational-age (AGA) and small-for-gestational-age (SGA) babies was performed at our hospital from August 1989 to July 1990. A total of of 512 cases were included, 432 cases in the AGA group and 80 cases in the SGA group, with gestational ages ranging from 26 to 42 weeks. Umbilical arterial blood was collected immediately after delivery of the newborns. Comparisons of maternal age, gestational age, birth body weight and body length of infants. Apgar scores at one minute and five minutes, cord arterial blood pH, pO2, pCO2, base excess, bicarbonate, total CO2, O2 saturation and O2 content between the AGA and SGA groups were taken into account. Our results demonstrated significant differences in birth body weight, birth body length, Apgar scores at one minute and five minutes and gestational age in the SGA group compared with those in the AGA group. The parameters of cord arterial blood gas were not correlated with gestational age in either group. The mean pH value in the AGA group (7.30 +/- 0.05) was higher than that in the SGA group (7.28 +/- 0.08). The same trend of difference was also noted between the AGA (7.30 +/- 0.04) and SGA (7.27 +/- 0.07) babies who were delivered by Cesarean section (p < 0.05). The latter results imply a more academic state in SGA babies which is independent of labor. Prepartum asphyxia plays an important role in determining the prognosis of SGA babies. We suggest routine umbilical cord blood gas and acid-base analysis at delivery to assess fetal asphyxia.     

Effect of magnitude and timing of maternal pregnancy blood lead (Pb) levels on birth outcomes.

OBJECTIVE: Associations between magnitude and timing of maternal pregnancy blood lead (Pb) levels (BLLs), birth weight, and total days of gestation were examined, as well as associations with related clinical diagnoses of low birth weight (LBW), preterm, and small-for-gestational-age (SGA) birth. STUDY DESIGN: Among a sample of 262 mother-infant pairs studied retrospectively, one-way analysis of variance and regression statistics were used to measure the relationship between level of maternal pregnancy BLLs and birth outcomes while controlling for key maternal and newborn factors. RESULTS: Women with maximum pregnancy BLLs (max-PBLLs) > or =10 microg/dl tended to give birth earlier and their babies were at substantially increased risk for preterm and SGA birth. By holding other explanatory factors constant, each unit increase in max-PBLL above 10 mug/dl was found to be associated with a decrease of -0.3 in total days of gestation. Compared to women with lower levels, women with max-PBLLs > or =10 microg/dl were at a threefold increased risk for preterm birth (adjusted OR=3.2, 95% CI 1.2-7.4) and more than a fourfold increased risk for having an SGA infant (adjusted OR=4.2, 1.3-13.9). Second trimester maximum BLLs > or =10 microg/dl were associated with a steep decrease in total days of gestation (a decrease of -1.0 days per each unit increase above 10 microg/dl). CONCLUSIONS: These data provide evidence of the adverse effects of maternal pregnancy BLLs, particularly when levels are > or =10 microg/dl. Prenatal Pb exposure at these levels was associated with significant decreases in total days of gestation and an increased risk of preterm and SGA birth.     

Perinatal correlates and neonatal outcomes of small for gestational age infants born at term gestation

OBJECTIVE: We sought to examine the current perinatal correlates and neonatal morbidity associated with intrauterine growth failure among neonates born at term gestation. STUDY DESIGN: We compared 372 small for gestational age (SGA, birth weight <10th percentile) infants born at term gestation to 372 appropriate for gestational age controls (AGA, birth weight 10th to 90th percentile) matched by sex, race, and gestational age within 2 weeks. RESULTS: Compared with AGA controls, significant (P < .05) maternal risk factors for SGA status included single marital status (59% versus 53%), lower prepregnancy weight (144 +/- 41 lbs versus 153 +/- 40 lbs), lower weight gain during pregnancy (29 +/- 15 lbs versus 33 +/- 15 lbs), smoking (25% versus 17%), hypertension (14% versus 7%), and multiple gestation (9% versus 2%). Mothers of SGA infants were more likely to undergo multiple (>or=3) antenatal ultrasound evaluations (19% versus 7%), biophysical profile monitoring (11% versus 4%), and oxytocin delivery induction (28% versus 16%) (P < .05). Pediatrician attendance was more common among SGA deliveries (50% versus 37%, P < .05). SGA infants had significantly higher rates of hypothermia (18% versus 6%) and symptomatic hypoglycemia (5% versus 1%). These neonatal problems remained significant even when medical or pathologic causes of intrauterine growth failure, including pregnancy hypertension, multiple gestation, and congenital malformations, were excluded. CONCLUSION: Despite higher rates of pregnancy complications among mothers of SGA infants, the rates of neonatal adverse outcomes are low. However, SGA infants remain at risk for hypothermia and hypoglycemia and require careful neonatal surveillance.     

The effect of hypertension in pregnancy on fetal and neonatal condition

The aim of this prospective study was to determine the effect of hypertension in pregnancy (PH) on fetal and neonatal condition via other mechanisms than retarded intrauterine growth and preterm delivery. Sixty-six preterm and 175 full-term babies born to PH mothers were compared, respectively, with 183 preterm and 220 full-term babies born to non-hypertensive (non-PH) mothers over a 22-month period in 1984-1986. Small-for-gestational-age (SGA) children were examined separately from appropriate-for-gestational-age (AGA) children. Percentages of preterm babies and of both preterm and full-term SGA babies born to hypertensive mothers were twice as great as the percentages of such babies born to non-hypertensive mothers. Hypertension in pregnancy directly increased neonatal morbidity, but the effect was minor. In preterm babies it was related to intrauterine growth retardation and to pre-eclampsia. In full-term babies the effect was unrelated to the severity of hypertension.     

Perinatal predictors of neurodevelopmental outcome in small-for-gestational-age children at 18 months of age

OBJECTIVE: Our purpose was to explore the influence of a range of perinatal variables on neurodevelopment at 18 months in a cohort of small-for-gestational-age (SGA) children born in the mid 1990s. STUDY DESIGN: Two hundred eighty-two SGA children (birth weight <10th centile) were followed up prospectively; 220 (78%) had Bayley Scales of Infant Development II performed at 18 months' corrected age. RESULTS: The mean (SD) gestation at delivery was 36.5 (2.7) weeks and mean birth weight was 2095 (549) g. The mean Bayley Scales of Infant Development scores were as follows: Mental Developmental Index score, 95.6 (14.5); Psychomotor Developmental Index score, 97.9 (14.8); and Behavioural Rating Scale score, 110.6 (13.5). SGA children whose mothers had pregnancy-induced hypertension were less likely to have low Mental Development Index scores than SGA children whose mothers were normotensive during pregnancy (10 [23%] vs 78 [44%]. P =.01). Low Psychomotor Development Index scores were associated with not being breast-fed at 3 months (odds ratio [OR] 3.5; 95% CI 1.2-10.1) and long neonatal nursery stay (OR 2.8, 95% CI 1.02-7.05). A low Behavioral Rating Scale score was associated with a large z score for head circumference at birth (OR 2.4, 95% CI 1.2-4.8) and cord arterial base deficit (OR 1.2, 95% CI 1.01-1.4). CONCLUSION: Few of the perinatal variables previously reported are predictive of early childhood outcome in this modern cohort of SGA infants.     

Effects of glucocorticoids during pregnancy on the outcome of the children directly after birth and in the long run.

We studied 17 mothers and the outcome of their 34 pregnancies. The purpose of this retrospective study was to determine possible adverse effects on growth of prolonged use of glucocorticoids, which have been recommended for short-term use in the prevention of respiratory distress syndrome (Liggins). There was no effect on duration of pregnancy; no congenital abnormalities were seen in this small group of children when corticoids were used during the whole pregnancy. There was a slight decrease in birth weight and placenta weight and, when known, also in length in almost every case. However, after long-term follow-up all of these children except 1 showed a catch-up growth and were slightly above normal. Their neurological and mental development was also normal except in 1 child who was born severely asphyxiated. We conclude from these results that there appears to be no adverse effect on later growth in the use of glucocorticoids during pregnancy. Therefore, it is unlikely that the short-term use of glucocorticoids as recommended by Liggins would have any influence on later growth.     

Somatic classification of neonates based on birth weight, length, and head circumference: quantification of the effects of maternal BMI and smoking

We defined neonates as small, appropriate, or large for gestational age (SGA, AGA, LGA) based on birth weight, length, and head circumference. We analyzed the effects on the somatic classification of maternal body mass index (BMI) (<18.5, 18.5-24.99, 25.0-29.99, ≥ 30) and smoking during pregnancy (0, 1-7, 8-14, ≥ 15 cigarettes daily). Data were from the German Perinatal Survey (1998-2000; 433,669 cases). The following refers to the classification by birth weight. In the normal maternal weight population SGA rates increased with cigarette consumption: 9.8%, 17.8%, 21.6%, and 25.4% for non-smokers, and smokers of 1-7, 8-14, and ≥ 15 cigarettes daily, respectively. In non-smoking underweight women the SGA rate was 17.4%. In underweight smokers of ≥ 15 cigarettes daily the SGA rate was 38.5% [odds ratio 5.77, 95% confidence interval 5.10-6.53, compared with normal weight non-smokers]. In the normal maternal weight population, LGA rates were 9.9%, 5.3%, 4.6%, and 3.5% for non-smokers, and smokers of 1-7, 8-14, and ≥ 15 cigarettes daily, respectively. In the obese, LGA rates were 20.9% (non-smokers) and 11.4% (≥ 15 cigarettes). Similar findings were obtained for the somatic classifications based on birth length and head circumference. Results for the various combinations of maternal BMI and smoking status in the three classification systems are described. Our findings may assist in individualized risk assessment for SGA and LGA births.     

Total body water in small- and appropriate- for gestational age newborns

OBJECTIVES: To ascertain total body water in small for gestational age (SGA) and appropriate for gestational age (AGA) newborns. METHODS: SGA and AGA babies were matched by gestational age and studied from birth to term age. Criteria for exclusions were genetic syndromes, malformations, and congenital infections. Bioelectrical impedance was performed at two days of life (term infants), or at seven days of life and term age (preterm infants). Weight and length were measured by trained interviewers, and Z-score, weight/length ratio and Rohrer ponderal index was calculated. RESULTS: Of the 54 infants evaluated, 28 were SGA (17 preterm) and 26 were AGA (15 preterm). Total body water was greater in SGA preterm babies at seven days of age (P=0.058) and at term age (P<0.0001). Weight/length ratio and Rohrer ponderal index increased towards term. Weight Z-score and anthropometric measures at term were significantly smaller in SGA babies. Being SGA and variation in Rohrer ponderal index influenced the variations in total body water. CONCLUSIONS: SGA babies had greater total body water, and both groups presented insufficient increase in body solid mass, stressing the importance of nutritional support during neonatal care.     

Postnatal placental confirmation of trisomy 2 and trisomy 16 detected at chorionic villus sampling: a possible association with intrauterine growth retardation and elevated maternal serum alpha-fetoprotein.

Detection of trisomy 2 and trisomy 16 mosaicism through chorionic villus sampling (CVS) is not an infrequent finding. We describe here two cases, one of non-mosaic trisomy 2 and the other of high level mosaicism for trisomy 16. Amniocentesis in both cases demonstrated non-mosaic 46,XY karyotypes. Each pregnancy continued to delivery of liveborn, normal-appearing boys; both pregnancies were complicated by severe intrauterine growth retardation (IUGR). Postnatal studies of placental biopsies in both cases confirmed the original CVS findings, whereas cord blood karyotypes were normal in both boys. Both children have demonstrated adequate catch-up growth.     

Exposure to active and passive smoking during pregnancy and severe small for gestational age at term

Objective. The objective of this study was to assess the relationship between active smoking as well as environmental tobacco smoke (ETS) exposure and severe small for gestational age (SGA) at term in a sample of pregnant Italian women.

Methods. A case–control study was conducted in nine cities in Italy between October 1999 and September 2000. Cases of severe SGA were singleton, live born, at term children with a birth weight ≤ 5^th percentile for gestational age. Controls (10:1 to cases) were enrolled from among singleton at term births that occurred in the same hospitals one or two days after delivery of the case, with a birth weight > 10^th percentile for gestational age. A total of 84 cases of severe SGA and 858 controls were analyzed. A self-administered questionnaire was used to assess active smoking and ETS exposure, as well as potential confounders.

Results. Multivariate logistic regression analysis showed a relationship between active smoking during pregnancy and severe SGA (adjusted odds ratio (OR) 2.10, 95% confidence interval (CI) 1.13–3.68). ETS exposure was associated with severe SGA (adjusted OR 2.51, 95% CI 1.59–3.95) with a dose–response relationship to the number of smokers in the home.